Medical billing services in Virginia
Billing, coding, credentialing and A/R follow-up for providers in Virginia.
Billing in Virginia: what is different
Cardinal Care managed care plans cover most Virginia Medicaid members. Medicare Part B in Arlington and Fairfax counties and the City of Alexandria is handled by Novitas (JL).
Key payers and contractors in Virginia
- Medicare Part A/B
- Palmetto GBA, Jurisdiction JMPortal: Palmetto GBA eServices
- Medicare DME
- CGS, DME MAC Jurisdiction CDME supplier claims only · Portal: myCGS
- Medicaid
- Virginia Medicaid (Cardinal Care)Portal: MES Provider Portal
- Blue Cross Blue Shield
- Anthem Blue Cross and Blue Shield, and CareFirst in Northern Virginia
- Medicare Advantage
- UnitedHealthcare, Humana, Aetna, Wellcare, Blue plans and others, depending on the county
Contractor assignments and plan lists change. We confirm the current setup for your practice during onboarding.
How we work with Virginia providers
- Medicaid enrollment with the state, then credentialing with each managed care plan you need
- Medicare enrollment through PECOS and claims with Palmetto GBA through Palmetto GBA eServices
- Credentialing and contracting with commercial and Blue plans
- Eligibility checks that confirm each patient’s plan and assigned MCO before the visit
- Prior authorization tracking by plan
- Denial, appeal and A/R follow-up under each payer’s filing limits
Medical billing in Virginia: common questions
Do you bill Virginia Medicaid and its managed care plans?
Yes. We bill Virginia Medicaid fee-for-service claims and each Medicaid managed care plan, after confirming the patient’s assigned plan for the date of service.
Who processes Medicare claims in Virginia?
Medicare Part A and B claims in Virginia are processed by Palmetto GBA (Jurisdiction JM), and we submit and track them through Palmetto GBA eServices. Part B claims from Arlington and Fairfax counties and the City of Alexandria go to Novitas Solutions (Jurisdiction JL) instead, through Novitasphere. DME supplier claims go to a different contractor, CGS (DME MAC Jurisdiction C), through myCGS.
Can you credential new providers in Virginia?
Yes. We handle state Medicaid enrollment, Medicare enrollment, CAQH and credentialing with the commercial and managed care plans you need in Virginia.
Neighboring states and key payers
Get a free billing audit for your Virginia practice
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.